Trends in Cannabis-positive Urine Toxicology Test Results: US Veterans Health Administration Emergency Department Patients, 2008 to 2019

Fink, David S.; Malte, Carol A.; Cerdá, Magdalena; Mannes, Zachary L.; Livne, Ofir; Martins, Sílvia S.; Keyhani, Salomeh; Olfson, Mark; McDowell, Yoanna E.; Gradus, Jaimie L.; Wall, Melanie M.; Sherman, Scott E.; Maynard, Charles; Saxon, Andrew J.; Hasin, Deborah S.

doi:10.1097/adm.0000000000001197

Cited by 4 publications

(3 citation statements)

References 36 publications

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“…Finally, cannabis use variables could have appeared to increase due to reductions in stigma leading to greater reporting over time. However, our findings that urine toxicology tests positive for cannabis in VHA patients also increased over time 38 suggests that the increases in prevalence of the self-reported cannabis measures in both datasets were not entirely due to reduced stigma of cannabis use. 38 In conclusion, this study adds to evidence that the adult prevalences of any past-year non-medical use, frequent non-medical use and CUD are increasing faster among individuals with psychiatric disorders than among individuals without psychiatric disorders.…”

Section: Discussionmentioning

confidence: 66%

“…However, our findings that urine toxicology tests positive for cannabis in VHA patients also increased over time 38 suggests that the increases in prevalence of the self-reported cannabis measures in both datasets were not entirely due to reduced stigma of cannabis use. 38 In conclusion, this study adds to evidence that the adult prevalences of any past-year non-medical use, frequent non-medical use and CUD are increasing faster among individuals with psychiatric disorders than among individuals without psychiatric disorders. The consistency of findings between the older data from representative samples of adults in the general population with the more recent findings on data across among veteran patients treated at the VHA supports the validity of each, and suggests that information gleaned from VHA data may have applicability and utility to patient groups beyond those treated by the VHA.…”

Section: Discussionmentioning

confidence: 66%

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Cannabis Use and Cannabis Use Disorder among U.S. Adults with Psychiatric Disorders: 2001-2002 and 2012-2013

Hasin,

Mannes,

Livne

et al. 2024

Preprint

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Objective: Rates of cannabis use disorder (CUD) have increased disproportionately among Veterans Health Administration (VHA) patients with psychiatric disorders, but determining whether such an increase occurred more generally among U.S. adults requires nationally representative data. Methods: Data came from 2001-2002 (n=43,093) and 2012-2013 (n=36,309) national surveys. Outcomes were any past-year non-medical cannabis use, frequent non-medical use (≥3 times weekly), and DSM-IV CUD. Psychiatric disorders included mood, anxiety disorders, antisocial personality disorder, and bipolar I. Logistic regressions were used to generate predicted marginal prevalences of the outcomes for each survey, risk differences calculated, and additive interaction tests determined whether between-survey differences in risk of cannabis outcomes differed between those with and without psychiatric conditions. Results: Cannabis outcome prevalences increased more among those with than without any psychiatric disorder. The difference in prevalence differences included any past-year non-medical cannabis use, 2.45% (95%CI=1.29, 3.62); frequent non-medical cannabis use, 1.58% (95%CI=0.83, 2.33); CUD, 1.40% (95%CI=0.58, 2.21). For each specific disorder, prevalences increased more among those with the disorder, except CUD among those with antisocial personality disorder. Conclusions: In the U.S. general population, rates of cannabis use and CUD increased at a greater rate among adults with psychiatric disorders, similar to findings from VHA patients. These results suggest that although VHA patients are not representative of all U.S. adults, findings from this important patient group can be informative. As U.S. cannabis use continues to expand, greater clinical and policy attention to CUD is needed for adults with psychiatric disorders.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 66%

Cannabis Use and Cannabis Use Disorder among U.S. Adults with Psychiatric Disorders: 2001-2002 and 2012-2013

Hasin,

Mannes,

Livne

et al. 2024

Preprint

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“…5 The main outcome was ≥1 UDS positive for Δ-9-tetrahydrocannabinol (THC) metabolite during an ED visit in a given year. 6 To estimate the role of MCL and RCL enactment in the national increases in cannabis positive UDS prevalence using all yearly information from 2008 to 2019, a staggered adoption difference-in-difference (DiD) model was used. 7 The DiD estimates for MCL-only and MCL/RCL associations were obtained from a linear binomial regression model with fixed effects for state, categorical year, time-varying law status, individual-level covariates (age, sex, race/ethnicity), and time-varying state-level covariates (age, sex, race/ethnicity, income, poverty, unemployment).…”

Section: Methodsmentioning

confidence: 99%

Association of Cannabis Legalization with Cannabis Positive Drug Screening in US Veterans

Fink,

Samples,

Malte

et al. 2023

Preprint

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BackgroundAlthough cannabis legalization is associated with increases in self-report cannabis use, biological measures of cannabis use are needed to address potential bias introduced by improved self-reporting of cannabis use in states enacting medical cannabis laws (MCL) and recreational cannabis laws (RCL).ObjectiveQuantify the role of MCL and RCL enactment in cannabis positive urine drug screen (UDS) prevalence among Veterans Health Administration (VHA) emergency department (ED) patients from 2008 to 2019.DesignStaggered-adoption difference-in-difference analysis were used to estimate the role of MCL and RCL in cannabis positive UDS data, fitting adjusted linear binomial regression models to estimate the association between MCL and RCL enactment and prevalence of cannabis positive UDS.ParticipantsVHA enrolled veterans aged 18-75 years with ≥1 ED visit in a given year from 2008 to 2019.Main MeasuresReceipt of ≥1 cannabis positive UDS during an ED visit were analyzed.Key ResultsFrom 2008 to 2019, adjusted cannabis positive UDS prevalences increased from 16.4% to 25.6% in states with no cannabis law, 16.6% to 27.6% in MCL-only enacting states, and 18.2% to 33.8% in RCL-enacting states. MCL-only and MCL/RCL enactment was associated with a 0.8% (95% CI, 0.4-1.0) and 2.9% (95% CI, 2.5-3.3) absolute increase in cannabis positive UDS, respectively. Significant effect sizes were found for MCL and RCL, such that 7.0% and 18.5% of the total increase in cannabis positive UDS prevalence in MCL-only and RCL states could be attributed to MCLs and RCLs.ConclusionsIn this study of VHA ED patients, MCL and RCL enactment played a significant role in the overall increases in cannabis positive UDS. The increase in a biological measure of cannabis use reduces concerns that previously documented increases in self-reported cannabis use from surveys are due to changes in patient willingness to report use as it becomes more legal.

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Trends in Opioid Use Disorder in the Veterans Health Administration, 2005-2022

Gorfinkel,

Malte,

Fink

et al. 2024

JAMA Netw Open

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ImportanceGiven the personal and social burdens of opioid use disorder (OUD), understanding time trends in OUD prevalence in large patient populations is key to planning prevention and treatment services.ObjectiveTo examine trends in the prevalence of OUD from 2005 to 2022 overall and by age, sex, and race and ethnicity.Design, Setting, and ParticipantsThis serial cross-sectional study included national Veterans Health Administration (VHA) electronic medical record data from the VHA Corporate Data Warehouse. Adult patients (age ≥18 years) with a current OUD diagnosis (using International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] codes) who received outpatient care at VHA facilities from January 1, 2005, to December 31, 2022, were eligible for inclusion in the analysis.Main Outcomes and MeasuresThe main outcome was OUD diagnoses. To test for changes in prevalence of OUD over time, multivariable logistic regression models were run that included categorical study year and were adjusted for sex, race and ethnicity, and categorical age.ResultsThe final sample size ranged from 4 332 165 to 5 962 564 per year; most were men (89.3%-95.0%). Overall, the annual percentage of VHA patients diagnosed with OUD almost doubled from 2005 to 2017 (0.60% [95% CI, 0.60%-0.61%] to 1.16% [95% CI, 1.15%-1.17%]; adjusted difference, 0.55 [95% CI, 0.54-0.57] percentage points) and declined thereafter (2022: 0.97% [95% CI, 0.97%-0.98%]; adjusted difference from 2017 to 2022, −0.18 [95% CI, −0.19 to −0.17] percentage points). This trend was similar among men (0.64% [95% CI, 0.63%-0.64%] in 2005 vs 1.22% [95% CI, 1.21%-1.23%] in 2017 vs 1.03% [95% CI, 1.02%-1.04%] in 2022), women (0.34% [95% CI, 0.32%-0.36%] in 2005 vs 0.68% [95% CI, 0.66%-0.69%] in 2017 vs 0.53% [95% CI, 0.52%-0.55%] in 2022), those younger than 35 years (0.62% [95% CI, 0.59%-0.66%] in 2005 vs 2.22% [95% CI, 2.18%-2.26%] in 2017 vs 1.00% [95% CI, 0.97%-1.03%] in 2022), those aged 35 to 64 years (1.21% [95% CI, 1.19%-1.22%] in 2005 vs 1.80% [95% CI, 1.78%-1.82%] in 2017 vs 1.41% [95% CI, 1.39%-1.42%] in 2022), and non-Hispanic White patients (0.44% [95% CI, 0.43%-0.45%] in 2005 vs 1.28% [95% CI, 1.27%-1.29%] in 2017 vs 1.13% [95% CI, 1.11%-1.14%] in 2022). Among VHA patients aged 65 years or older, OUD diagnoses increased from 2005 to 2022 (0.06% [95% CI, 0.06%-0.06%] to 0.61% [95% CI, 0.60%-0.62%]), whereas among Hispanic or Latino and non-Hispanic Black patients, OUD diagnoses decreased from 2005 (0.93% [95% CI, 0.88%-0.97%] and 1.26% [95% CI, 1.23%-1.28%], respectively) to 2022 (0.61% [95% CI, 0.59%-0.63%] and 0.82% [95% CI, 0.80%-0.83%], respectively).Conclusions and RelevanceThis serial cross-sectional study of national VHA electronic health record data found that the prevalence of OUD diagnoses increased from 2005 to 2017, peaked in 2017, and declined thereafter, a trend primarily attributable to changes among non-Hispanic White patients and those younger than 65 years. Continued public health efforts aimed at recognizing, treating, and preventing OUD are warranted.

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Trends in Cannabis-positive Urine Toxicology Test Results: US Veterans Health Administration Emergency Department Patients, 2008 to 2019

Cited by 4 publications

References 36 publications

Cannabis Use and Cannabis Use Disorder among U.S. Adults with Psychiatric Disorders: 2001-2002 and 2012-2013

Cannabis Use and Cannabis Use Disorder among U.S. Adults with Psychiatric Disorders: 2001-2002 and 2012-2013

Association of Cannabis Legalization with Cannabis Positive Drug Screening in US Veterans

Trends in Opioid Use Disorder in the Veterans Health Administration, 2005-2022

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